# Developing a crisis leadership evaluation system for Chinese nursing staff during major infectious disease emergencies: a modified Delphi study

## TL;DR

This study developed a crisis leadership evaluation system for Chinese nursing staff during major infectious disease emergencies using a modified Delphi method.

## Contribution

The study introduces a new evaluation system for crisis leadership among nursing staff in infectious disease emergencies in China.

## Key findings

- A consensus-based framework with 6 primary, 18 secondary, and 38 tertiary indicators was established.
- High reliability was confirmed with authority coefficients of 0.88 and 0.93 in two Delphi rounds.
- Weights for primary indicators were determined using the analytical hierarchy process.

## Abstract

To create a consensus on the nursing crisis leadership evaluation system during major infectious disease emergencies.

Crisis leadership is critical to prevent and mitigate an infectious disease infectious disease public health emergency during crisis time. However, there has been no crisis leadership evaluation system for nursing staff during major infectious diseases emergencies in China.

We used a two-part modified Delphi method. Part 1 focused on creating a pool of indicators and developing an evaluation framework through a systematic literature review and a qualitative interview. Part 2 revised the indicators and built the final the evaluation system using two rounds of the Delphi surveys, following the Conducting and REporting of DElphi Studies (CREDES) guidance. Indicators were scored by a panel of experts based on the 5-point Likert scale. The weights of the indicators at each level were identified by analytical hierarchy process (AHP) methods.

A consensus was reached on a framework for assessing crisis leadership in nursing. Experts who met the inclusion criteria participated in round 1 (n = 23) and 2 (n = 19). The recovery rates for the two rounds of the Delphi survey were 92% and 82%. The authority coefficients (Cr) were 0.88 and 0.93, respectively, indicating the high reliability of the consultation results. The Kendall coefficients (W) of the two rounds were 0.106 and 0.150 (P < 0.001). The final consensus set comprised 6 primary indicators, 18 secondary indicators, and 38 tertiary indicators. The Weights of the six primary indicators allocated by AHP, namely loading the responsibility, heading the team, governing the situation, foreseeing the crisis, thriving on crisis, and insisting on the faith, were 0.3056, 0.2500, 0.1944, 0.1389, 0.0833, and 0.0278.

A consensus-based, contemporary set of nursing crisis leadership evaluation systems in the context of major infectious disease emergencies has been identified. Ongoing work is needed to further develop a highly reliable scale, determine the current state of nursing crisis leadership, construct a targeted training curriculum, and implement the program into practice that managers may wish to use to assess, select, and develop the next generation of nursing leaders.

The online version contains supplementary material available at 10.1186/s12912-025-03050-8.